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Critical care trials

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https://www.readbyqxmd.com/read/29052691/discontinuing-inappropriate-medication-use-in-nursing-home-residents-a-cluster-randomized-controlled-trial
#1
Hans Wouters, Jessica Scheper, Hedi Koning, Chris Brouwer, Jos W Twisk, Helene van der Meer, Froukje Boersma, Sytse U Zuidema, Katja Taxis
Background: Inappropriate prescribing is a well-known clinical problem in nursing home residents, but few interventions have focused on reducing inappropriate medication use. Objective: To examine successful discontinuation of inappropriate medication use and to improve prescribing in nursing home residents. Design: Pragmatic cluster randomized controlled trial, with clustering by elder care physicians and their wards. (ClinicalTrials.gov: NCT01876095)...
October 10, 2017: Annals of Internal Medicine
https://www.readbyqxmd.com/read/29051909/performance-monitoring-in-children-following-traumatic-brain-injury-compared-to-typically-developing-children
#2
Amy A Wilkinson, Maureen Dennis, Margot J Taylor, Anne-Marie Guerguerian, Kathy Boutis, Karen Choong, Craig Campbell, Douglas Fraser, Jamie Hutchison, Russell Schachar
Children with traumatic brain injury are reported to have deficits in performance monitoring, but the mechanisms underlying these deficits are not well understood. Four performance monitoring hypotheses were explored by comparing how 28 children with traumatic brain injury and 28 typically developing controls (matched by age and sex) performed on the stop-signal task. Control children slowed significantly more following incorrect than correct stop-signal trials, fitting the error monitoring hypothesis. In contrast, the traumatic brain injury group showed no performance monitoring difference with trial types, but significant group differences did not emerge, suggesting that children with traumatic brain injury may not perform the same way as controls...
January 2017: Child neurology open
https://www.readbyqxmd.com/read/29050521/glutamate-receptor-antagonists-with-the-potential-for-migraine-treatment
#3
Anna Ferrari, Cecilia Rustichelli, Carlo Baraldi
Preclinical, clinical, and other (e.g., genetic) evidence support the concept that migraine susceptibility may at least partially result from a glutamatergic system disorder. Therefore, the receptors of the glutamatergic system are considered relatively new targets for investigational drugs to treat migraine. Investigational and established glutamate receptor antagonists (GluRAs) have been shown to possess antinociceptive properties in preclinical models of trigeminovascular nociception and have been evaluated in clinical trials...
October 19, 2017: Expert Opinion on Investigational Drugs
https://www.readbyqxmd.com/read/29049526/incorporating-patient-and-caregiver-experiences-into-cardiovascular-clinical-trial-design
#4
Sean P Collins, Phillip D Levy, Jane L Holl, Javed Butler, Yosef Khan, Tiffany L Israel, Gregg C Fonarow, Jacqueline Alikhaani, Eric Sarno, Alison Cook, Clyde W Yancy
Patient centeredness is a concept that is increasingly being viewed as essential for clinical research. A core principle involves a comprehensive assessment and integration of patient and caregiver perspectives into trial design. Importantly, this involves more than just soliciting feedback. Patients and caregivers are now considered vital members of the study team, even serving as coinvestigators who may help to conceive, plan, and develop the study; continue to direct the day-to-day conduct of the study; and fully participate in the dissemination of the study results...
October 11, 2017: JAMA Cardiology
https://www.readbyqxmd.com/read/29049285/2009-2010-influenza-a-h1n1-related-critical-illness-among-aboriginal-and-non-aboriginal-canadians
#5
James J Jung, Ruxandra Pinto, Ryan Zarychanski, Deborah J Cook, Philippe Jouvet, John C Marshall, Anand Kumar, Jennifer Long, Rachel Rodin, Robert A Fowler
BACKGROUND: Preliminary studies suggested that Aboriginal Canadians had disproportionately higher rates of infection, hospitalization, and critical illness due to pandemic Influenza A(H1N1)pdm09. METHODS: We used a prospective cohort study of critically ill patients with laboratory confirmed or probable H1N1 infection in Canada between April 16 2009 and April 12 2010. Baseline characteristics, medical interventions, clinical course and outcomes were compared between Aboriginal and non-Aboriginal patients...
2017: PloS One
https://www.readbyqxmd.com/read/29047353/precision-medicine-for-all-challenges-and-opportunities-for-a-precision-medicine-approach-to-critical-illness
#6
REVIEW
Christopher W Seymour, Hernando Gomez, Chung-Chou H Chang, Gilles Clermont, John A Kellum, Jason Kennedy, Sachin Yende, Derek C Angus
All of medicine aspires to be precise, where a greater understanding of individual data will lead to personalized treatment and improved outcomes. Prompted by specific examples in oncology, the field of critical care may be tempted to envision that complex, acute syndromes could bend to a similar reductionist philosophy-where single mutations could identify and target our critically ill patients for treatment. However, precision medicine faces many challenges in critical care. These include confusion about terminology, uncertainty about how to divide patients into discrete groups, the challenges of multi-morbidity, scale, and the need for timely interventions...
October 18, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/29046809/hospital-resuscitation-teams-a-review-of-the-risks-to-the-healthcare-worker
#7
REVIEW
Stephen M Vindigni, Juan N Lessing, David J Carlbom
BACKGROUND: "Code blue" events and related resuscitation efforts involve multidisciplinary bedside teams that implement specialized interventions aimed at patient revival. Activities include performing effective chest compressions, assessing and restoring a perfusing cardiac rhythm, stabilizing the airway, and treating the underlying cause of the arrest. While the existing critical care literature has appropriately focused on the patient, there has been a dearth of information discussing the various stresses to the healthcare team...
2017: Journal of Intensive Care
https://www.readbyqxmd.com/read/29042484/accuracy-of-oxygen-flow-delivered-by-compressed-gas-cylinders-in-hospital-and-prehospital-emergency-care
#8
Frédéric Duprez, Jean Bernard Michotte, Gregory Cuvelier, Alexandre Legrand, Sharam Mashayekhi, Gregory Reychler
BACKGROUND: Oxygen cylinders are widely used both in hospital and prehospital care. Excessive or inappropriate FIO2 may be critical for patients with hypercapnia or hypoxia. Moreover, over-oxygenation could be deleterious in ischemic disorders. Supplemental oxygen from oxygen cylinder should therefore be delivered accurately. The aim of this study was to assess the accuracy of oxygen flows for oxygen cylinder in hospital and prehospital care. METHODS: A prospective trial was conducted to evaluate accuracy of delivered oxygen flows (2, 4, 6, 9 and 12 L/min) for different oxygen cylinder ready for use in different hospital departments...
October 17, 2017: Respiratory Care
https://www.readbyqxmd.com/read/29042299/non-pharmacological-interventions-for-spasticity-in-adults-an-overview-of-systematic-reviews
#9
REVIEW
Fary Khan, Bhasker Amatya, Djamel Bensmail, Alain Yelnik
OBJECTIVES: Spasticity causes significant long-term disability-burden, requiring comprehensive management. This review evaluates evidence from published systematic reviews of clinical trials for effectiveness of non-pharmacological interventions for improved spasticity outcomes. METHODS: Data sources: A literature search was conducted using medical and health science electronic (MEDLINE, EMBASE, CINAHL, PubMed, and the Cochrane Library) databases for published systematic reviews up to 15(th) June 2017...
October 14, 2017: Annals of Physical and Rehabilitation Medicine
https://www.readbyqxmd.com/read/29040214/untreated-relative-hypotension-measured-as-perfusion-pressure-deficit-during-management-of-shock-and-new-onset-acute-kidney-injury-a-literature-review
#10
Rakshit Panwar
Maintaining an optimal blood pressure (BP) during shock is a fundamental tenet of critical care. Optimal BP targets maybe different for different patients. In current practice, too often, uniform BP targets are pursued which may result in inadvertently accepting a degree of untreated relative hypotension i.e., the deficit between patients' usual pre-morbid basal BP and the achieved BP, during vasopressor support. Relative hypotension is a common but an under-recognized and an under-treated sign among patients with potential shock state...
October 16, 2017: Shock
https://www.readbyqxmd.com/read/29039683/a-systematic-review-of-federal-drug-administration-docket-for-community-consultation-and-public-disclosure-in-exception-from-informed-consent-trials
#11
Adrianne N Haggins, Deneil Harney, Sara Scott, Robert Silbergleit
BACKGROUND: Exception from informed consent imposes community consultation and public disclosure requirements on clinical investigation in critically ill and injured patients. In 2011, the Food and Drug Administration instructed sponsors to submit publically disclosed information to the Food and Drug Administration Docket, but to date there has been no comprehensive analysis of available data. We summarized the community consultation and public disclosure practices of exception from informed consent trials published on the Food and Drug Administration Docket in order to better understand the breadth of common practices that exists among acute care clinical research...
October 1, 2017: Clinical Trials: Journal of the Society for Clinical Trials
https://www.readbyqxmd.com/read/29037226/xingnaojing-for-moderate-to-severe-acute-ischemic-stroke-xmas-study-protocol-for-a-randomized-controlled-trial
#12
Xinxing Lai, Kegang Cao, Lingbo Kong, Qiang Liu, Ying Gao
BACKGROUND: Xingnaojing injection (XNJ) is widely used for the treatment of stroke in China. However, there is currently a lack of high-quality evidence of its efficacy for acute ischemic stroke. The main objective of this study is to determine whether the addition of XNJ to standard care improves the 3-month functional outcome in patients with acute ischemic stroke (AIS). METHODS/DESIGN: The XMAS study is a multicenter, prospective, randomized controlled, open-label trial with a blinded endpoints design...
October 16, 2017: Trials
https://www.readbyqxmd.com/read/29036629/nanotechnology-a-promising-new-paradigm-for-the-control-of-pain
#13
Krishnan V Chakravarthy, Frank J Boehm, Paul J Christo
Objective: The objective of this article is to critically review both preclinical and clinical studies that focus on the use of nanotechnology for both acute and chronic pain management, surveying both diagnostic and therapeutic applications. The article also provides information on nanotechnology for pain practitioners, so that they may better understand how this technology works and how it may be applied to their day-to-day clinical practice. Study Design: Narrative review...
June 27, 2017: Pain Medicine: the Official Journal of the American Academy of Pain Medicine
https://www.readbyqxmd.com/read/29035924/rotational-therapy-in-thoracic-injuries-what-is-the-evidence
#14
Philipp Störmann, Ingo Marzi, Sebastian Wutzler
PURPOSE OF REVIEW: To review the current use of continuous lateral rotational therapy (CLRT) in patients with thoracic injuries and its impact on clinical course, complications and outcome. RECENT FINDINGS: Patient positioning is a key factor in the treatment of severe thoracic injuries and CLRT, and intermittent supine and prone position are basic options. There is a lack of randomized controlled studies for trauma patients with chest injury undergoing kinetic therapy as standard of care...
October 14, 2017: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29035841/verification-of-an-improved-hip-joint-center-prediction-method
#15
Emily J Miller, Kenton R Kaufman
In motion analysis, the hip joint center (HJC) is used to define the proximal location of the thigh segment and is also the point about which hip moments are calculated. The HJC cannot be palpated; its location must be calculated. Functional methods have been proposed but are difficult to perform by some clinical populations. Therefore, regression methods are utilized, but yield large errors in estimating the HJC location. These prediction methods typically utilize the anterior and posterior superior iliac spines, where excessive adipose tissue makes correctly locating difficult...
October 10, 2017: Gait & Posture
https://www.readbyqxmd.com/read/29028418/cancer-center-clinic-and-research-team-perceptions-of-identity-and-interactions
#16
Torsten Reimer, Simon J Craddock Lee, Sandra Garcia, Mary Gill, Tobi Duncan, Erin L Williams, David E Gerber
PURPOSE: Conduct of cancer clinical trials requires coordination and cooperation among research and clinic teams. Diffusion of and confusion about responsibility may occur if team members' perceptions of roles and objectives do not align. These factors are critical to the success of cancer centers but are poorly studied. METHODS: We developed a survey adapting components of the Adapted Team Climate Inventory, Measure of Team Identification, and Measure of In-Group Bias...
October 13, 2017: Journal of Oncology Practice
https://www.readbyqxmd.com/read/29028072/vitamin-d-in-human-reproduction-the-more-the-better-an-evidence-based-critical-appraisal
#17
A S Laganà, S G Vitale, H Ban Frangež, E Vrtačnik-Bokal, R D'Anna
OBJECTIVE: Vitamin D is a fat-soluble secosteroid hormone that regulates calcium, magnesium, and phosphate homeostasis and plays a pivotal role as antiproliferative and immunomodulatory mediator. Considering the different sources of synthesis and dietary intake as well as the pleiotropic actions in extremely diverse (micro)environments of the body, the supplementation of this Vitamin should be carefully evaluated taking into account the several pathways that it regulates. In the current brief review, we aimed to summarize the available evidence about the topic, in order to suggest the best evidence-based supplementation strategy for human reproduction, avoiding the unuseful (and sometimes hazardous) empiric supplementation...
September 2017: European Review for Medical and Pharmacological Sciences
https://www.readbyqxmd.com/read/29023260/dysphagia-in-mechanically-ventilated-icu-patients-dynamics-a-prospective-observational-trial
#18
Joerg C Schefold, David Berger, Patrick Zürcher, Michael Lensch, Andrea Perren, Stephan M Jakob, Ilkka Parviainen, Jukka Takala
OBJECTIVES: Swallowing disorders may be associated with adverse clinical outcomes in patients following invasive mechanical ventilation. We investigated the incidence of dysphagia, its time course, and association with clinically relevant outcomes in extubated critically ill patients. DESIGN: Prospective observational trial with systematic dysphagia screening and follow-up until 90 days or death. SETTINGS: ICU of a tertiary care academic center...
October 11, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/29023252/partner-notification-for-youth-living-with-hiv-in-14-cities-in-the-united-states
#19
Jacob J van den Berg, Marjan Javanbakht, Pamina M Gorbach, Bret J Rudy, Andrew O Westfall, Craig M Wilson, Michelle A Lally
BACKGROUND: Identifying factors associated with partner notification among youth living with HIV is critical for effective HIV prevention and treatment strategies. METHODS: A total of 924 male and female behaviorally-infected youth ages 13-24 across 14 U.S. cities completed an audio-computer assisted self-interview including questions about demographics and experiences with patient- and provider-referral partner notification. RESULTS: The majority of participants self-identified as male (82...
October 4, 2017: Journal of Acquired Immune Deficiency Syndromes: JAIDS
https://www.readbyqxmd.com/read/29020010/assay-optimisation-and-technology-transfer-for-multi-site-immuno-monitoring-in-vaccine-trials
#20
Steven G Smith, Stephanie A Harris, Iman Satti, Donna Bryan, K Barry Walker, Hazel M Dockrell, Helen McShane, Mei Mei Ho
Cellular immunological assays are important tools for the monitoring of responses to T-cell-inducing vaccine candidates. As these bioassays are often technically complex and require considerable experience, careful technology transfer between laboratories is critical if high quality, reproducible data that allows comparison between sites, is to be generated. The aim of this study, funded by the European Union Framework Program 7-funded TRANSVAC project, was to optimise Standard Operating Procedures and the technology transfer process to maximise the reproducibility of three bioassays for interferon-gamma responses: enzyme-linked immunosorbent assay (ELISA), ex-vivo enzyme-linked immunospot and intracellular cytokine staining...
2017: PloS One
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